Evaluation of a multifaceted vaginal health program in gynecologic cancer patients experiencing sexual dysfunction: A randomized controlled trial

Abstract

Objectives: To characterize those seeking treatment at a female sexual medicine (FSM) program and examine their sexual/vaginal health issues. The program was established to address the consequences of cancer treatment on vaginal health and sexuality. Methods: A limitedwaiver of authorizationwas obtained to evaluate the FSM Program. Demographic and medical information and FSM clinical assessment forms from 509 new visits were analyzed. The FSM clinical assessment form consists of a clinician evaluation form with the Vaginal Assessment Scale (VAS); patient-reported outcomes (PROs), including the Sexual ActivityQuestionnaire (SAQ), Sexual Self-SchemaScale (SSSS), and Female Sexual Function Index (FSFI); and exploratory items. Results: Of the 509 patients, 493 (97%) completed PROs. Due to staff changes, 253 of these women also received pelvic examinations. Most of the women seeking treatment had histories of breast (260 [51%]) or gynecologic (190 [37%]) cancer. Other cancers included colorectal/anal (35 [7%]), skin (20 [4%]), gastric/genitourinary (17 [3%]), andhematologic (17 [3%]). Eighty-one percent of patients weremarried or partnered. The median age was 51.6 years (mean, 51 years). On pelvic examination, approximately two-thirds of patients had elevated vaginal pH scores (5– 6.5 [35%] or 6.5+ [33%]) andminimal (62%) or no (5%) vaginal moisture. Eighty-seven patients (44%) experienced pain during their examinations (25%mild, 12%moderate, 2% severe). Fifty-three percent of patientswere sexually active, but only 43% felt confident about sexual activity. The degree of concern about sexual function/vaginal health was significant, with a mean of 7.9 on a scale of 0 (not at all) to 10 (very much). Approximately half had moderate/severe dryness (133 [51%]) and dyspareunia (120 [46%]) per the VAS. The mean SSSS score was 60.7, indicating a slightly positive sexual self-view. However, 93% (429) had an FSFI score below 26, suggesting sexual dysfunction. Conclusions: At initial consultation, women reported symptoms of vaginal dryness, pain, and sexual dysfunction. Pelvic examinations for many women revealed elevated vaginal pH, lack of moisture, and discomfort with the examination itself. Future analyses will examine changes over time. Our goal is to provide information, strategies, and support to improve symptomswhile promoting confidence about sexual/ vaginal health.